Term
| Difference between acute and chronic diarrhea |
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Definition
Acute = < 3 days
Chronic = >14 days |
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Term
| 6 possible causes of chronic diarrhea |
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Definition
1. intestinal infx
2. inflammatory bowel disease
3. malabsorption
4. secretory hormonal tumor
5. drug, factitious
6. Motility disturbance |
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Term
| Give 5 antimotility agents |
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Definition
Diphenoxylate
Loperamide
Paregoric
Opium tincture
Difenoxin |
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Term
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Definition
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Kaolin-pectin mixture
Polycarbophil
Attapulgite |
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Term
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Definition
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Bismuth subsalicylate
Enzymes (lactase)
Bacterial replacement (Lactobacillus acidophilus, Lactobacillus bulgaricus) |
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Term
What is the formula for BMI?
Give the 6 classifications of BMI. |
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Definition
Formula: weight (kg) / [height (m)2
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Term
What is the difference between overweight and obesity?
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Definition
•Overweight
- Excess body weight relative to height; determined by BM.
-
obese = excess body fat = determined by fat analysis.
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Term
MOA of this anti-obesity meds:
Orlistat & Cetilistat
ephedrine
topiramate
caffeine
phentermine
fluoxetine
diethylpropion
sibutramine
locarserin
rimonabant
tensofesine
Which two were withdrawn from market and why? |
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Definition
Orlistat & Cetilistat - inhibits fat absorption lipase
ephedrine- increase energy consumption and thermogenesis --> discontinued due to MI. stroke and arrhythmias
topiramate - anticonvulsant
caffeine - increase energy consumption and thermogenesis
phentermine - appetite suppression (sympathomimetic)
fluoxetine - appetite suppression (SSRI)
diethylpropion - appetite suppression (sympathomimetic)
sibutramine - appetite suppression (SNRI) --> discontinued due to MI and stroke.
locarserin - appetite suppression (selective 5-HT2C agonist)
rimonabant - appetite suppression (endocannabinoid type 1 receptor inhibition)
tensofesine - appetite suppression (Norepinephrine, dopamine & serotonin reuptake inhibition) |
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Term
Influences on food intake (give example & MOA):
central receptor
peripheral receptors
intestinal peptides
ghrelin
leptin
neuropeptide Y
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Definition
central receptor- ex. 5HT, histamine, dopamine, NE --> stimulates/decrease food intake
peripheral receptors - beta adrenergic receptors on fat --> thermogenesis and lipolysis (caffeine and ephedrine)
intestinal peptides - cholecystokinin, pancreatic polypeptide --> signals decrease food intake after meal
ghrelin --> released from stomach to stimulate appetite
leptin - released by adipose tissue --> appetite suppression
neuropeptide Y - inhibits energy expenditure and stimulates increase food intake |
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Term
| Goal of anti-obesity agents |
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Definition
| Achieve negative energy balance |
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Term
Most of weight loss occurs in first ____
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Definition
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Term
| Give brand name, ideal patient and 2 counseling for orlistat |
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Definition
Alli or Xenical
Target: ptns with risk of diabetes or with ~30% fat diet
1. Take 60 mg Alli or 120 mg Xenical with fatty food 3x a day
2. ADR include flatulence, abdominal pain, incontinence and fecal urgency |
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Term
| Name 4 and give 4 counseling points for noradrenergic appetite suppressants |
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Definition
Phentermine, diethylpropion, benzphetamine, phendimetrazine
1. Stop if no weight loss in 4 weeks
2. Tolerance to drug is common, stop if tolerance is developed
3. FDA approved for short term use (<12 weeks)
4. High addiction potential |
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Term
| Safest Noradrenergic Appetite Suppressant Agents for cardiovascular system? |
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Definition
| diethylproprion (Tenuate, tepanil) |
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Term
| MOA and Indication of lorcaserine |
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Definition
MOA: 5-HT2C agonist
For:
1. Obese (BMI >30 kg/m2)
2. BMI >27 + HTN, DM or hyperlipidemia |
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Term
| Counselig point for lorcaserin |
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Definition
•Discontinue therapy if at least 5% weight loss not achieved within 12 weeks of starting therapy
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Term
Which drug:
•High study drop out rate during trial
~50% achieve 5% weight loss in 1 year
•20-25% achieve 10% weight loss in 1 year
•Weight loss maintained out to 2 years
•Reductions in BP, LDL/TGs, glucose
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Definition
| Lorcaserine - 5-HT2C agonist |
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Term
Adverse effects
Dizziness, fatigue, nausea
Dry mouth, constipation
Hypoglycemia (in diabetics)
Headache, backpain, cough (in diabetics)
Safety warnings
Valvular heart disease
Bradycardia
Malignancy
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Definition
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Term
| What is the approved combination agent for weight loss. Give their individual class and the drug's indication |
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Definition
Phentermine (sympathomimetic) + Topiramate (antiepileptic)
Indication (same as Lorcaserine/belviq):
1. Obese BMI >30
2. BMI >27 + HTN, DM or dysL |
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Term
Which weight loss agent needs to be titrated? what is the criteria for titration?
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Definition
Qsymia - Phentermine/Topiramate combination
Titrate only when ptn is losing weight |
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Term
2 Counseling points for Qsymia.
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Definition
1. Titrate dose up only if ptn is losing weight.
2.—Discontinue if patient does not lose weight and always taper off over 1 week
—Initial 3.75mg(P)/23 mg(T)QD X 14 days
—Titrate to 7.5mg/46 mg QD X 12 weeks
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Term
| This agent should not be stopped immediately, always taper off over 1 week. |
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Definition
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Term
While on phentermine/topiramate, what do you do if ptn has:
3% wt loss
5% wt loss |
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Definition
3% weight loss?
If not (if < 3% wt loss) = discontinue use
Or increase to 11.25/69 mg QD X 14 days, then 15/92 mg QD
5% weight loss after 12 weeks of 15/92mg dose?
Gradually discontinue therapy (taper dose over 1 wk)
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Term
| Which 2 agents are good for cardiovascular disorder (improves it)? |
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Definition
Phentermine/topiramate >> diethylpropion
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Term
ADR:
Dry mouth, constipation, insomnia, parathesias
Tachycardia
Hypertension
Cognitive dysfunction
Neuropsychiatric -Depression, anxiety
Metabolic -Hypokalemia, metabolic acidosis
Nephrolithiasis
Caution:
Hypertension
Glaucoma
Diabetes
Mood disorders (depression, anxiety, insomnia)*
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Definition
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Term
- Abnormal reflux of gastric contents into the esophagus causing symptoms OR mucosal damage
- Heartburn that occurs 2 or more days per week
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Definition
Gastroesophageal Reflux Disease (GERD)
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Term
a reflex hypersalivation induced by esophageal reflux
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Definition
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Term
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Definition
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